Jan 30

And win an autographed first edition copy of  Peter Ubel’s new book—by coming up with creative titles!

 

I saw the great suggestions you gave to Dan about his new book, and would love to get similar help with my latest book. I’m Peter Ubel, a colleague of Dan’s at Duke University, and my new book is about medical decision-making, specifically the challenge that doctors and patients face trying to talk together about healthcare alternatives in ways that will help them pick the choice that is best for the individual patient.

 

In the old days, and I’m not talking about that long ago, medical decisions weren’t shared affairs. Doctors made decisions and patients, largely, obeyed.   Then in the 1970s, the traditions of medical decision making ran head-on into patients (and lawyers and a new breed of people called ethicists) who demanded that doctors involve patients more actively in their decisions.  Now, doctors are taught that the best choice is often not merely a medical decision, but instead hinges on patient values. Under this new paradigm, the physician’s job is to inform patients about their alternatives so that each individual patient can decide which choice fits them best.

 

Sometimes this new paradigm works great. But too often, it fails miserably. It often starts when physicians like me try to inform patients about their health care conditions.  For example, consider a conversation I quote in the book, in which a hematologist describes the risks and benefits of treating leukemia to his patient:

“So if you look at complete cytogenetic response rates in the chronic phase, it’s about 80%, and if you look at the accelerated phase, it’s about 15%.  So, the drug doesn’t work in advanced disease very well. If you look at patients who get a complete cytogenetic response as their best response in the Iris trial, their risk of ever progressing in the next 4 years, so about 48 months roughly, is about 8% overall.”

“That’s good,” the patient replied.

“Yeah.  So, and this is divided into people who become Philadelphia chromosome positive but appear to be in chronic phase.  And half of these are people who go to accelerated phase or blast crisis.  If you look at people who had complete cytogenetic response, this is people who had complete cytogenetic remission at any time of the trial, … if you look at people who are at complete cytogenetic remission at 6 months like you are, this is probably less than 5%, so”

“Say that part again,” the patient interjected, “because I didn’t quite follow you.”

 

You didn’t?  Did you forget to go to medical school or something?

 

Problem 1, then, is that we doctors don’t always know how to explain things to our patients in terms they understand.  Problem 2, as readers of this site know all too well, is that even when people DO understand the facts, they are still, . . . how should I put this, . . . predictably irrational.  Like Dan, I’ve spent much of my career discovering the irrational forces that influence people’s decisions, and in this book I show these forces at work in the context of medical decision making.

 

Fortunately, there is a way out of this mess.  After telling stories of “medical decisions gone wild,” I lay out ways doctors and patients can work together to make better decisions.  I discuss some cool new research that shows what we need to do to achieve shared decision-making between doctors and patients.  I show how to move beyond the simple, and wrong, idea that giving patients information will make them empowered, rational decision-makers.

 

That’s the gist. Any pithy titles come to mind? If any of you come up with an idea that leads me to my eventual title, I will mail you an autographed copy of my book when it comes out next fall.

 

Thanks.

Peter Ubel